The word emergency conjures images of large-scale disasters, such as earthquakes or outbreaks of war. But a large part of MSF’s work focuses on providing care in hidden emergencies which, while receiving little media coverage, can be just as serious.
In every situation, MSF strives to ensure that we target people who may be overlooked by the authorities or by other aid groups. These might include prostitutes, street children, prisoners, drug addicts or the mentally ill. In some contexts, entire populations are systematically neglected by the relevant authorities because of ethnic or political reasons.
When people are ostracised from society or are forgotten by their governments, MSF can step in to help heal their mental and physical wounds and provide a voice on their behalf.
With decades of experience, MSF takes time to develop thorough understanding of the people we treat and the places in which we operate. For neglected people who can’t reach medical facilities, we take the care to them.
Libya is a lawless state fragmented by conflicts and both a destination and a place of transit for hundreds of thousands of refugees, asylum seekers and migrants. In migrant detention centres, they face arbitrary detention for prolonged periods of time in unsanitary and inhumane conditions. There is no way to challenge the lawfulness of their detention, virtually no access to the outside world, ill-treatment and a lack of access to medical care.
MSF provides medical assistance to migrants and refugees arbitrarily held in detention centres in Libya. Most medical complaints are related to the conditions in which they are detained, with overcrowding, inadequate food and drinking water, and insufficient latrines resulting in respiratory tract infections, musculoskeletal pain, skin diseases such as scabies infestations, and diarrhoeal diseases.
MSF is calling for an end to the arbitrary detention of migrants and refugees in Libya, calling it harmful and exploitative. We are calling for an end to European governments’ migration policies to seal off the coast of Libya and ‘contain’ migrants, asylum seekers and refugees in a country where they are exposed to extreme, widespread violence and exploitation.
Violence, drug abuse and sex workers
In some countries, people are excluded from healthcare because they are forced to live outside of normal societal bounds.
Sex workers and men who have sex with men have both a higher risk of contracting HIV and a lower access to antiretroviral care due to stigma and discrimination as well as, in many instances, their illegal status and high mobility.
After identifying a high rate of HIV on a truckers’ route in South-east Africa, MSF launched an ambitious “Corridor” project spanning Mozambique, Malawi and Zimbabwe.
Reaching out to the most vulnerable requires considerable investment in time and human resources. Cecilia, our peer educator in Zalewa, Malawi, is a former sex worker herself, and can understand the perspective of other sex workers. “I’m proud of working as a peer educator: I feel like I’m a good example to the other sex workers,” she says. “The girls know me, they see me with them every day, and as a result they trust me more than they would trust anybody else.”
MSF doctors diagnose the people they meet and provide first aid. Psychologists provide counselling and stand ready to listen to what the people have to say. Others with more serious or chronic health problems and addictions are referred to our healthcare facilities, where MSF doctors and psychologists provide additional medical care for physical, sexual and psychological violence and support patients throughout their treatment.
In many countries, certain medical conditions – especially mental and psychological disorders – are handled primarily by silence. Taboo can be as big a health problem as any.
Some 450 million people worldwide suffer from mental health disorders, according to the World Health Organization (WHO), yet an enormous gap exists between those who need healthcare and those who receive it.
MSF’s Mental Health expert in Iraq, Greg Keane, an Australian psychologist, explains how there was a huge demand for mental healthcare following the 2017 conflict in Mosul.
“I remember one day, in a 45-degree tent, everyone literally dripping with sweat. Person after person clamouring for mental health support for them or their families. That day I diagnosed a young man with his first presentation of a psychotic illness, convincing his devastated mum and dad that he wasn’t possessed by a genie – that medication might help – and that things could be okay for them,” he said.